Having insurance doesn't mean getting care. A new secret shopper study found that fewer than 1 in 4 calls to in-network mental health providers actually resulted in a scheduled appointment, with inaccurate provider directories being the biggest culprit. The findings raise serious questions about whether existing regulations are doing enough to protect patients.
Having insurance is supposed to open doors to care — but a new peer-reviewed study suggests those doors are often locked, at least when it comes to mental health. Researchers from Ohio State University and Stanford made over 5,800 secret shopper calls to psychiatrists and psychologists listed as in-network across five large commercial insurance plans. Only 23.6% of evaluable calls ended in a scheduled appointment, exposing the widespread reality of so-called "ghost networks" — providers listed as available who simply aren't.
The biggest barrier? Bad data. More than half of evaluated calls (55.6%) ran into inaccurate directory information — wrong phone numbers, disconnected lines, or providers who had moved or left their practice entirely. Nearly 22% hit a wall due to provider capacity constraints. Appointment success rates varied by state, ranging from 18% in Virginia to 32.9% in New Jersey.
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Why it matters: These findings arrive three years after directory accuracy rules under the No Surprises Act took effect — and researchers say the data suggests those rules lack teeth. With CMS now proposing stricter directory update requirements for Medicare Advantage plans, the pressure is mounting on commercial insurers to clean up their listings and ensure patients can actually access the care they're paying for.
